BEUDAMED
    FDA Adverse Event Malfunction Summary report: Y

    ACTIV.A.C. ION PROGRESS REMOTE THERAPY MONITORING SYSTEM

    MDR report key: 10141492 · Received June 10, 2020

    Report

    Report Number
    3009897021-2020-00227
    Event Type
    Malfunction
    Date Received
    June 10, 2020
    Date of Event
    April 9, 2020
    Report Date
    September 29, 2020
    Manufacturer
    KINETIC CONCEPTS, INC.
    Product Code
    OMP
    UDI-DI
    00849554005600
    PMA / PMN Number
    K201571
    Removal / Correction Number
    3009897021-5-15-20-001-C
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    MDR-3009897021-2020-00227 SUBMITTED ON (B)(6) 2020 NOTED THAT IT WAS A SUMMARY OF 2 EVENTS FOUND IN REPAIR AND MULTIPLE SECTIONS WERE INADVERTENTLY LEFT BLANK. CORRECTION THIS REPORT IS FOR ONE EVENT ASSOCIATED WITH SERIAL NUMBER VRTM02668 INFORMATION IN B5 AND H10 HAVE BEEN UPDATED TO REFLECT SUCH AND BLANK SECTIONS WERE COMPLETED. SECTION D4 UNIQUE IDENTIFIER (UDI) # WAS UPDATED TO REFLECT THE FULL UDI NUMBER. SECTION G5 PMA/510(K) NOTED K063692 CORRECTION SECTION G4 PMA/510(K) K201571 SECTION G7 TYPE OF REPORT WAS BLANK CORRECTION SECTION G7 TYPE OF REPORT 30-DAY BASED ON THE CORRECTIONS; KCI'S ASSESSMENT REMAINS THE SAME. DURING THE REPAIR PROCESS, KCI FOUND EVIDENCE THAT THE DEVICE HAD A COLLAPSED POWER SWITCH DOME. THE POWER SWITCH WAS REPLACED. THERE IS NO PATIENT INVOLVEMENT AND THERE IS NO INJURY REPORTED TO KCI ASSOCIATED WITH THIS EVENT. KCI IS REPORTING THIS EVENT FOUND DURING SERVICING OF THE UNIT AS A DEVICE MALFUNCTION THAT HAS THE POTENTIAL TO RESULT IN INJURY IF THE MALFUNCTION WERE TO RECUR. DISCLAIMER: THIS INFORMATION IS SUBMITTED PURSUANT TO 21 CFR 803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT A KINETIC CONCEPTS, INC. PRODUCT MALFUNCTIONED, IS DEFECTIVE OR HAS CAUSED SERIOUS INJURY.

    Description of Event or Problem · 0

    KCI IDENTIFIED THE ACTIV.A.C.¿ ION PROGRESS¿ REMOTE THERAPY MONITORING SYSTEM HAD A COLLAPSED POWER BUTTON/SWITCH DURING THE REPAIR PROCESS. THE POWER SWITCH WAS REPLACED. THERE IS NO PATIENT OR INJURY ASSOCIATED WITH THIS EVENT.

    Additional Manufacturer Narrative · 1

    ADDITIONAL DEVICE INFORMATION FOR MALFUNCTION EVENTS SUMMARIZED IN THIS REPORT: DATE OF EVENT: THE MALFUNCTION EVENTS OCCURRED BETWEEN (B)(6) 2020 AND (B)(6) 2020. SERIAL #: ADDITIONAL SERIAL NUMBER INCLUDED IN THIS SUMMARY REPORT: (B)(4). UNIQUE IDENTIFIER (UDI) #: (B)(4). DATE RECEIVED BY MANUFACTURER: KCI IDENTIFIED THE MALFUNCTION EVENTS BETWEEN 09-APR-2020 AND 08-MAY-2020. DEVICE MANUFACTURE DATE: THE DEVICES INCLUDED IN THIS SUMMARY REPORT WERE MANUFACTURED BETWEEN 01-FEB-2018 THROUGH 09-AUG-2018. DURING THE REPAIR PROCESS, KCI FOUND EVIDENCE THAT THE DEVICES EACH HAD A COLLAPSED DOME. THE POWER SWITCH WAS REPLACED. THERE IS NO PATIENT INVOLVEMENT AND THERE ARE NO INJURIES REPORTED TO KCI ASSOCIATED WITH THESE EVENTS. KCI IS REPORTING THESE EVENTS FOUND DURING THE REPAIR PROCESS AS DEVICE MALFUNCTIONS THAT HAVE THE POTENTIAL TO RESULT IN INJURY IF THE MALFUNCTION WERE TO RECUR.

    Description of Event or Problem · 1

    THIS REPORT SUMMARIZES <NOE> 2 </NOE> MALFUNCTION EVENTS. KCI IDENTIFIED THE ACTIV.A.C.¿ ION PROGRESS¿ REMOTE THERAPY MONITORING SYSTEMS HAD COLLAPSED POWER BUTTONS/SWITCHES DURING THE REPAIR PROCESS AND THE POWER SWITCHES WERE REPLACED. THERE ARE NO PATIENTS OR INJURIES ASSOCIATED WITH THESE EVENTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    605251 ACTIV.A.C. ION PROGRESS REMOTE THERAPY MONITORING SYSTEM OMP OMP KINETIC CONCEPTS, INC. WNDARM 00849554005600

    Patients

    Seq Age Sex Outcome Treatment
    1